Malaria Flashcards
What is used for acute uncomplicated falciparum malaria?
Artemether with lumefantrine
Atovaquone with proguanil
What is used for the prophylaxis of falciparum malaria?
Atovaquone with proguanil
What is used for the treatment of non-falciparum malaria?
Chloroquine
If the infective species is not known or if the infection is mixed, what is, and what is not, a suitable anti-malarial?
Chloroquine is not suitable.
Quinine is suitable. Atovaquone with proguanil hydrochloride is suitable. Artemether with lumefantrine is suitable.
In what ages can doxycycline be used for the prophylaxis of malaria in areas of chloroquine resistance?
12+
What medicines can be used for the prophylaxis of malaria in areas of chloroquine resistance?
Doxycycline and mefloquine and atovaquone with proguanil
What anti-malarials are not suitable for the treatment of falciparum malaria owing to resistance?
Mefloquine and chloroquine
What insect repellent is effective against bites?
Diethyltoluamide (20-50%)
Diethyltoluamide (DEET) can be used in which groups of people?
Over 2 months of age, pregnant, and breastfeeding.
Advise breastfeeding mothers to wash their hands and breast tissue before handling infants.
What advice can be given to people using diethyltoluamide?
Apply DEET after sunscreen as DEET reduces the SPF of sunscreen. SPF 30-50 should be applied.
What is the length of prophylaxis for chloroquine? (short-term)
1 week before travel and for 4 weeks after leaving the area.
What is the length of prophylaxis for proguanil hydrochloride? (short-term)
1 week before travel and for 4 weeks after leaving the area.
What is the length of prophylaxis for mefloquine? (short-term)
2-3 weeks before travel and up to 4 weeks after leaving the area.
What is the length of prophylaxis for atovaquone with proguanil hydrochloride? (short-term)
1-2 days before travel and up to 1 week after leaving the area.
What is the length of long-term prophylaxis for mefloquine?
1 year
What is the length of long-term prophylaxis for doxycycline?
2 years
What is the length of long-term prophylaxis for atovaquone with proguanil hydrochloride?
1 year
After return from a malarial region, what length of time could a person still be at risk for malaria?
3 months to 1 year
What anti-malarial medications are not suitable for people with epilepsy?
Chloroquine and mefloquine
What anti-malarial medications are suitable for people with epilepsy?
Doxycycline or atovaquone with proguanil
Which individuals are at particular risk of malaria?
Asplenic individuals or those with severe splenic dysfunction
Which anti-malarials can be given during pregnancy?
Chloroquine and proguanil hydrochloride
Mefloquine can also be used (caution in first trimester)
What supplementation should be given to pregnant women who are taking proguanil hydrochloride?
Folic acid, for the length of time proguanil hydrochloride is used during pregnancy
What anti-malarial is contra-indicated during pregnancy?
Doxycycline as it affects teeth and skeletal development
What special precautions should be taken for people taking warfarin sodium travelling to a malarial region?
Must have chemoprophylaxis 2-3 weeks before departure and must ensure stable INR before departure. Measure INR before chemoprophylaxis, 7 days after starting, and upon return.
When should emergency standby treatment be given to a person and what should be provided?
No access to medical care. Provide written instructions to seek urgent medical attention if fever develops 7 days or more after arriving in an area with a high risk of malaria and how to administer emergency treatment.
What advice can be given to settled immigrants in the UK who have arrived from abroad (in relation to malaria)?
Immunity is lost rapidly, and an area that was previously non-malarious can become malarious.
How do you treat falciparum malaria?
Oral quinine by mouth for 5-7 days together with or followed by doxycycline for 7 days.
Alternatively, Malarone (atovaquone with proguanil) or Riamet (artemether with lumefantrine).
How is falciparum malaria treated in pregnancy?
Oral and intravenous quinine (adult dose).
How do you treat non-falciparum malaria caused by P. Malariae and P. knowlesi?
Chloroquine
How do you treat non-falciparum malaria caused by P. vivax and P. ovale?
Primaquine [unlicensed] after chloroquine
How do you treat P. vivax or P. ovale in pregnancy?
Postpone use of primaquine until pregnancy is over, and continue with chloroquine, given weekly.
How do you minimise the risk of ocular toxicity when giving chloroquine?
Do not exceed 4 mg/kg daily (equivalent to chloroquine base 2.5 mg/kg daily)
What are special cautions to bear in mind with mefloquine?
It is associated with serious neuropsychiatric reactions (abnormal dreams, anxiety, depression). May persist for several months due to its long half life.
What are special cautions to bear in mind with quinine?
It is associated with dose-dependent QT-interval-prolonging effects. Use in caution in patients with atrioventricular block or risk factors for QT prolongation.
How do you treat chronic hepatitis B?
Peginterferon alfa, a response should be achieved in 4 months. Alternatives are entecavir or tenofovir disoproxil, a response should be achieved within 6-9 months. Adefovir dipivoxil, lamivudine, or telbivudine are other options.
If no response in those time spans then discontinue.
How do you treat chronic hepatitis B and HIV together?
Tenofovir disoproxil is one option.
Another is tenofovir disoproxil with either emticritabine or lamivudine.
What are special warnings to bear in mind with the use of direct-acting anti-virals?
They may affect the efficacy of vitamin K antagonists therefore INR should be monitored closely.
Hepatitis B re-activation is possible in patients co-infected with hepatitis B and C when using direct-acting antiviral interferon-free regimens.
Rapid reduction in hepatitis C viral load may affect glucose metabolism in patients with diabetes and result in hypoglycaemia therefore monitor glucose levels within the first 3 months of treatment.
How do you treat mild chronic hepatitis C?
With peginterferon alfa and ribarivin (OR)
Ledipasvir with sofosbuvir (OR)
Sofosbuvir with peginterferon alfa and ribavirin (genotype 1, genotype 3 with cirrhosis, genotype 3 that has not adequately responded to interferon-based treatment, genotype 4, 5, or 6 with cirrhosis).
When treating chronic hepatitis C in patients with cirrhosis, what conditions should be met?
Child-Pugh class A, platelet count of 75kmm or more, no features of portal hypertension, no history of an HCV associated decompensation, and not previously treated with an NS5A inhibitor
